On Therapy
Dialectical Behavior Therapy
Therapy with Adolescents
Couples Therapy
My Policy on Managed Care and Insurance Reimbursement
I provide individual therapy, family therapy, group therapy, couples therapy, and combinations of the aforementioned types of therapy for adolescents (13 years old and older) and adults. Populations of special interest for me include adolescents and their families, young adults/college age individuals, and couples/marriage counseling. I have found that in most circumstances that work with adolescents (to one degree or another) is, by definition, family work. It has been my clinical experience that family therapy is the most powerful medium for real change in the lives of adolescents.
Your initial session involves a thorough evaluation of current problem areas in your life. After this initial session and for the next few sessions, I will develop a treatment plan. This treatment plan will contain goals that will evolve based on your changing life experience and the course of therapy. We will refer back to your treatment plan throughout therapy. Also, during your initial session we will discuss any questions you have about treatment, session parameters, fees, appointment schedule, and appointment cancellation.
Therapy will generally continue at agreed upon intervals. One session per week is typical, but it is not uncommon to meet more than once a week or every other week. Once a treatment plan is created we will generally agree upon longer intervals to review the need for treatment (generally 6 months to 1 year, but sometimes sooner).
In addition to traditional talk therapy, many of the techniques that I use are experiential and interactive. I also use metaphor and mindfulness in my practice. I believe that time spent in between sessions is just as important (if not more important) than time spent in session. For this reason I may give you assignments to be completed between sessions. We will then generally discuss these assignments at the beginning of the following session.
Termination of therapy generally happens when you reach your agreed upon treatment goals. Sometimes life circumstances will necessitate continued therapy or extension or addition to treatment goals. You, of course, have the right to discontinue therapy at any time; however, I might ask for one last wrap-up session to discuss your overall therapeutic experience and termination of treatment. You may return to therapy at any time in the future if you need additional assistance.
I have been intensively trained in Dialectical Behavioral Therapy (DBT). DBT is a cognitive behavioral based therapy that is one of the most well researched in the realm of evidence-based practice.Dialectics is the concept that in any given incidence, when one thing is true the opposite is also true. I practice the comprehensive, classic model of DBT. This model is composed of four components: weekly group skills training, weekly individual therapy, phone coaching, and weekly consultation team.
Group skills training is NOT therapy. Skills are taught in a traditional classroom setting and each training session lasts for 2.5 hours. Generally, skills are taught with two trainers, one of which may or may not be the individual therapist. The skills taught are in four areas: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. Mindfulness is a core component of DBT which is concept based on Zen Buddhism and Christian meditative tradition. Mindfulness means training your mind to live moment to moment (rather that focusing on the past or future). Distress tolerance is training oneself to tolerate emotionally volatile situations. Emotion regulation teaches individuals to understand, identify, and process emotions in a productive manner. Interpersonal effectiveness teaches participants to be assertive in a way that is centered but not aggressive. Issues that need additional processing are referred to the individual therapist.
Individual therapy is the appropriate place to process issues that present themselves on a weekly basis or that come up in skills training. My individual therapy sessions are 50 minute. The individual therapist is the leader of the treatment team for their individual client and any problems that occur are referred back to the individual therapist. Individual therapy follows a hierarchy of targets to be addressed. The primary targets are: suicidal/parasuicidal/life threatening behavior, therapy interfering behavior, and quality of life interfering behavior. All targets are dealt with in this order during each session. Individual therapy also involves examining these kinds of behavior in meticulous detail form the prior week and finding ways to use skills in this examination. The examination is referred to as a behavior chain analysis.
I am available to DBT clients all day at all hours for assistance with skills via telephone. Most skills coaching is brief (5-10 minutes maximum) and is not intended to be a "mini-therapy" session. Phone coaching allows clients assistance in using skills in the moments when they are needed in their lives. In these moments I will ask the client what they have tried and will make appropriate suggestions about other skills they might try.
The last component of classic DBT is consultation team. I meet with a small group of other mental health professionals on a weekly basis to review cases and to discuss the progress of clients in DBT. This meeting is meant as treatment for the therapist and lasts 1 ½ -2 hours. It allows me to gain outside assistance in managing problem areas within specific cases. This team approach to treatment is a very powerful component of DBT that translates to more effective treatment outcomes.
Couple relationships are rewarding and challenging at the same time. People in positive relationships tend to live longer, maintain better health, and adjust to life changes more readily. Negative relationships cause people to die younger, have more chronic undue stress, and possibly become subject to a whole host of physical and/or mental health problems. There are high rewards in functional relationships and high prices to pay in dysfunctional relationships. Additionally, even strong marriages go through rocky periods. Relationships can be a complicated endeavor.
In all relationships there is an ebb and flow to agreement and disagreement. The question is how can you nurturing your relationship and balance getting your own needs met?As a member of a couple you deserve to get some of your needs met some of the time. I can help you balance your needsand those of your significant other.
I also believe that couples counseling should be a collaborative process that takes into account the viewpoint of both partners. This honoring of each other's experience is critical for conflict to become graceful rather than hurtful. The goal in therapy is not to eliminate conflict, but to help contain emotions around conflict in a healthy manner. It is not about the fight itself but how you fight with each other that is important.
In my practice I use a combination of Gottman principles, Emotion Focused Couples Therapy, Alan Fruzetti's High Conflict Couple Therapy, and Terrence Real's Relational Recovery Therapy. I use scientifically proven methods to help you get the results you want in therapy.
Most adults who look back on their adolescence have strong associations with this important time in their lives. These memories may be positive or negative but they are almost always powerful. Adolescence is a time of tremendous energy and potential. I believe that young people are often stereotyped unfocused troublemakers. In many cases I think this stereotyping if harmful and unfounded. Many teenagers who wind up in my office find themselves falling into the self-fulfilling prophecy of these misconceptions. I see part of my job to help young people refocus this negative energy in productive ways. I encourage adolescents to cultivate a passion and to actualize this potential creatively and with purpose.
It has been my experience that to one degree or another all work with adolescents is family work. When I start seeing a teenager in my practice I will generally ask to see the young person individually and have a separate session with the parents. I then do an assessment of the family taking into account the perspective of both the parents and the adolescent. I make recommendations for treatment based on these initial sessions that almost always include family involvement. Sometimes I will meet with the adolescent individually, sometimes I will meet with the parents without the adolescent, sometimes I will meet with the whole family together, sometime I will meet with one parent and the adolescent. I believe in pushing families to communicate even if it is sometimes uncomfortable.
In my practice I do not accept managed care or insurance reimbursement. I will, however, generate a receipt if you would like to try to get partial or full reimbursement from you insurance plan. Payment for my services is generally due at the end of each session. Here are some things to keep in mind about managed care/ insurance:
Lack of Confidentiality
All managed care plans involve direct clinical management by these plan's case managers. If you access therapy through your MCP, it makes it necessary for your therapist to disclose anything and everything to related to your case to your MCP.
This information is then used by your MCP for determining benefits, which they allocate at their own discretion. This impacts your right of confidentiality, and it is possible that your information will be stored in a computer system which could be accessed by anyone.
The FBI and law enforcement officials can access your insurance information at any time. This information could be used to your disadvantage should a legal problem arise.
Furthermore, this lack of confidentiality could impact your minor children even more negatively. Should they ever desire to apply for certain jobs or educational programs, such law enforcement or the military, the information in their insurance files could be used against them.
Difficulty Getting Treatment Authorized
Due to the direct care management by MCP's and their desire to keep costs to a minimum, getting therapy sessions authorized often becomes cumbersome and time consuming. Every plan has different requirements and standards for authorizations. Usually they require many hours a week of paperwork and phone calls buy the therapist in order to get authorizations. Some will deny therapy in lieu of taking prescription medications.
MCP's allow a certain number of treatment sessions per year for each plan. Let's assume your MCP allows up to 20 sessions per year of outpatient psychotherapy. This does not mean you can automatically access your benefits. Often you first have to be referred by a primary care physician member of the MCP. Then you may have to go through a phone interview with an MCP case manager. Then you may have to contact several plan providers to find one who is accepting new clients, who has a convenient location, or who has expertise in your issues. Once you have found a provider, there may be a long wait for an appointment due to pre-authorization requirements. Then you are often given only one to three sessions to start (50 minutes per week - though you may feel you need more), as an assessment. Then you may need to wait for more visits to be authorized - often weeks of phone calls and paperwork flow back and forth between your provider and the MCP. Then the MCP may only authorize three sessions at a time, with this continual waiting period in between. This causes your treatment to be inconsistent, broken up, and can cause you more anxiety not knowing if you will in fact get your benefits authorized at all. It is the metaphorical equivalent of a surgeon opening up a patient on the operating table and then waiting for the insurance company to make the decide whether or not to let them sew the patient back up. Some clients give up on their treatment due to these frustrations.
Furthermore, some MCP's want to control the treatment plan. Some will even dictate the specific treatment plan, which is often very subjective and may even be anti-therapeautic. Some plans will determine when it is time to terminate treatment, even when the client continues to be in distress, or their problem has not been sufficiently solved.
Mis-Diagnosing and/or Over Diagnosing in Order to Get Treatment Authorized
Some MCP's will not cover treatment unless it is a "medical necessity." This may mean the client has to "pretend" they are "sick," or worse off than they are, in order to receive their benefits. Most MCP's do not cover marriage counseling, family counseling, or adjustment counseling, unless they are part of the treatment plan for a serious mental disorder or drug/alcohol problem. This situation puts both the therapist and client in a negative situation. Often the "assessment" sessions that are initially authorized are not sufficient to give an accurate diagnosis, yet the MCP will not authorize more visits without one. The therapist may be inclined to "make up" or "guess at " a diagnosis, which is not in the best interest of the client. Most importantly, you, the client, should not be given a mental illness diagnosis that is not correct, or is more serious than what is true, simply to get treatment paid by the MCP.
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